After a Measles Scare, Seattle Cracks Down on Vaccine Compliance 1

SEATTLE — After a measles outbreak sickened dozens of unvaccinated children in southwestern Washington State last year, school health administrators around the state went into crisis mode, intent on confronting the relatively low vaccination rates in the region.

First, they got an assist from the State Legislature, which passed a law in May tightening exemption rules for the measles, mumps and rubella vaccine. Then school districts — including Seattle’s — sent letters asking thousands of families who did not have compliant vaccine records to get them in order.

This week, Seattle Public Schools ramped up its effort even further, telling families that schools would turn away any remaining students who were not compliant.

At a time when states and school districts are exploring strategies to increase vaccination rates and avoid outbreaks, the tactics in Seattle appear to be paying off in a region with plenty of vaccine skepticism. The number of students with incomplete or noncompliant records — once around 7,000 — has dropped steadily to just a few hundred on Wednesday, the deadline for students to show their vaccination paperwork.

Samara Hoag, the manager of health services at Seattle Public Schools, said she was hearing every few minutes on Wednesday from staff members who were crossing names off the noncompliance list, as families either provided documentation or scheduled vaccination appointments.

“I’m ecstatic,” Ms. Hoag said. “We’ve seen the devastation of what happens when measles comes to visit.”

A year ago this week, a measles outbreak began in southwest Washington State, across the border from Portland, Ore. Along with other linked infections in Oregon and the Seattle area, state officials said the outbreak affected 71 people — the vast majority of them 18 years old or younger. Most were not immunized.

Oregon had another small outbreak soon after.

Washington responded by passing a law that would no longer allow families to claim a personal-belief exemption for the measles, mumps and rubella vaccine. Medical and religious exemptions are still allowed, as are personal exemptions for other vaccines. Ms. Hoag said that some who previously had personal exemptions were able to get new ones, but that others had gotten vaccinated.

Oregon, which has the nation’s highest rate of vaccine exemptions for kindergartners, considered but then abandoned legislation to tighten exemption rules.

Elizabeth Steiner Hayward, a Democratic state senator in Oregon who has worked for years to tighten vaccine rules, said Oregon had a “perfect storm” of communities on opposite ends of the political spectrum that comprised a large anti-vaccine presence. She said they included libertarians who are wary of government, others who feel it is unnatural to inject vaccines into bodies and religious groups that oppose immunization on principle.

“It scares me. It really does,” Ms. Steiner Hayward said. “I’ve seen people with measles. If we do end up with a cluster of this, I think a lot of people are going to get very sick, especially young children.”

Despite the robust opposition, Ms. Steiner Hayward said Oregon lawmakers had enough votes last year to eliminate nonmedical vaccine exemptions. But she said Gov. Kate Brown of Oregon had given up the issue in negotiations with Republicans, killing the bill.

In a statement on Wednesday, the governor’s office did not specifically address Ms. Steiner Hayward’s account but said Ms. Brown “continues to believe vaccination is critically important to the health of all Oregonians.”

Ms. Steiner Hayward said she did not expect the bill to advance this year, either.

In Seattle, Ms. Hoag said it was too early to say how much the new rules and enforcement would improve vaccination rates, but she was optimistic. Immunizations, she said, were especially important in a region that is a hub of cancer treatment centers, where patients who are also students in the district cannot get vaccinated for medical reasons and broader community vaccinations can help insulate them from infection.

Ms. Hoag added that having students’ records on file would help the region handle a potential outbreak: “I am much better prepared now to work with the Health Department to give them the data at each school and say, ‘These are the kids who are at risk because they are not vaccinated.’”